GC Registered Student Club and Organization Signature Page

Please Print or Type:
Date: ______________
Academic Year: ___________
Name of organization:
____________________________________________________________________

Officers:
1. Title: ______________________
Name: _________________________
Phone: _____________________
Email: _________________________
2. Title: ______________________
Name: _________________________
Phone: _____________________
Email: _________________________
3. Title: ______________________
Name: _________________________
Phone: _____________________
Email: _________________________
4. Title: ______________________
Name: _________________________
Phone: _____________________
Email: _________________________
I certify that the above information is accurate and that this organization will abide by college
rules and regulations, and all local, state, and federal laws. I have read and agree to comply with the
Student Organization Policies and Procedures. As the highest officer and official representative of the
organization I understand that I may be held responsible for activities or behavior of the organization and I
am liable for all debts and obligations incurred by the organization.
________________________________________
__________________
Signature of Highest Officer
Date
I understand the sponsors roles/ duties and agree to serve as a sponsor of the student
organization listed on this form.
PRIMARY SPONSOR:
Name: ____________________________________________
Office Location: _____________________________________
Office Telephone Number: ___________________cell #:_______________email___________________
Advisors signature:___________________________________date:___________________
This organization is approved ( ) or disapproved ( ) for the academic year.
______________________________
Director of Student Life
Updated 8//2013
_________________
Date